Provider Demographics
NPI:1326586488
Name:CANTRELL, ANN MARIE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:MARIE
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:URSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:460 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT VICTORY
Practice Address - State:OH
Practice Address - Zip Code:43340-8869
Practice Address - Country:US
Practice Address - Phone:937-354-2027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005013RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant